Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA.
J Cardiothorac Surg. 2024 Oct 3;19(1):585. doi: 10.1186/s13019-024-03101-2.
Despite key differences in pathological processes, both Intramural Hematomas and Aortic Dissections are Acute Aortic Syndromes repaired with similar surgical technique. The objective of this study was to determine differences in surgical outcomes between patients with Intramural Hematoma versus Type A Aortic Dissection undergoing Ascending Aortic Arch repair.
This retrospective review of prospectively collected data included all patients with acute Intramural Hematoma or Type A Aortic Dissection who underwent emergent Ascending- or Arch Repair from January 2018 to May 2023 at a single academic institution. Primary outcomes included intraoperative mortality, 30-Day mortality, and postoperative stay. Secondary outcomes included postoperative complications. Outcomes were analyzed using Chi-squared, Fisher's Exact, and t-tests, with significance set at p < 0.05.
A total of 107 patients were included, 27 of whom (25%) had Intramural Hematoma and 80 (75%) had Type A Aortic Dissection. There were no differences in preoperative characteristics such as age, gender, and comorbidities, and no differences in perioperative characteristics such as case length, cardiopulmonary bypass, aortic cross-clamp, and circulatory arrest times. When comparing postoperative outcomes, there was a higher rate of postoperative pericardial effusions requiring pericardial window in the Intramural Hematoma cohort compared to the Aortic Dissection cohort (15% [n = 4] vs. 3% [n = 2]; p = 0.02). There were no differences in other primary outcomes such as intraoperative mortality, 30-Day mortality, and postoperative length of stay. There were also no differences in the rates of postoperative complications such as bleeding requiring reoperation, cerebrovascular accident, atrial fibrillation, pleural effusion requiring thoracentesis, and surgery-related Emergency Department visits.
Our analysis demonstrates similar outcomes for patients undergoing Ascending Aortic Arch repair between patients with Intramural Hematoma and Type A Aortic Dissection. Despite the higher rate of required postoperative pericardial windows in the Intramural Hematoma cohort, the overall primary outcomes remained comparable. These findings better elucidate the standard of care for patients with acute Intramural Hematoma undergoing Ascending Aortic Arch repair.
尽管病理性过程存在关键差异，但壁内血肿和主动脉夹层都是采用相似的外科技术修复的急性主动脉综合征。本研究的目的是确定接受升主动脉弓修复的壁内血肿患者与急性 A 型主动脉夹层患者之间手术结果的差异。
这是一项回顾性分析，对 2018 年 1 月至 2023 年 5 月期间在一家学术机构接受急诊升主动脉或弓部修复的急性壁内血肿或急性 A 型主动脉夹层患者前瞻性收集的数据进行回顾性分析。主要结果包括术中死亡率、30 天死亡率和术后住院时间。次要结果包括术后并发症。采用卡方检验、Fisher 精确检验和 t 检验分析结果，显著性水平设为 p < 0.05。
共纳入 107 例患者，其中 27 例（25%）为壁内血肿，80 例（75%）为急性 A 型主动脉夹层。两组患者的术前特征如年龄、性别和合并症无差异，围手术期特征如手术时间、体外循环、主动脉阻断和循环暂停时间也无差异。比较术后结果，壁内血肿组术后并发需要行心包开窗引流的心包积液的发生率高于主动脉夹层组（15%[n=4] vs. 3%[n=2]；p=0.02）。术中死亡率、30 天死亡率和术后住院时间等其他主要结局无差异。术后并发症发生率如需要再次手术的出血、脑血管意外、心房颤动、需要胸腔穿刺引流的胸腔积液和与手术相关的急诊就诊也无差异。
我们的分析表明，壁内血肿和急性 A 型主动脉夹层患者接受升主动脉弓部修复的手术结果相似。尽管壁内血肿组术后需要心包开窗引流的比例较高，但总体主要结局仍相似。这些发现更清楚地阐明了急性壁内血肿患者接受升主动脉弓部修复的标准治疗方法。
